2013•CirculationRequires access
Outcome After Implantation of a Cardioverter-Defibrillator in Patients With Brugada Syndrome
Frédéric Sacher, Vincent Probst, Philippe Maury, Dominique Babuty, Jacques Mansourati, Yuki Komatsu, Christelle Marquié, Antonio De Rosa, Abou Diallo, Romain Cassagneau, Claire Loizeau, Raphaël Pedro Martins, Michael E. Field, Nicolas Derval, Shinsuke Miyazaki, Arnaud Denis, Akihiko Nogami, Philippe Ritter, Jean‐Baptiste Gourraud, Sylvain Ploux, Anne Rollin, Adlane Zemmoura, DOMINIQUE LAMAISON, Pierre Bordachar, Bertrand Pierre, Pierre Jaı̈s, Jean‐Luc Pasquié, Mélèze Hocini, François Legal, Pascal Defaye, Serge Bovéda, Yoshito Iesaka, Philippe Mabo, Michel Haı̈ssaguerre
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Abstract
BACKGROUND: Implantable cardioverter-defibrillator indications in Brugada syndrome remain controversial, especially in asymptomatic patients. Previous outcome data are limited by relatively small numbers of patients or short follow-up durations. We report the outcome of patients with Brugada syndrome implanted with an implantable cardioverter-defibrillator in a large multicenter registry. METHODS AND RESULTS: A total of 378 patients (310 male; age, 46±13 years) with a type 1 Brugada ECG pattern implanted with an implantable cardioverter-defibrillator (31 for aborted sudden cardiac arrest, 181 for syncope, and 166 asymptomatic) were included. Fifteen patients (4%) were lost to follow-up. During a mean follow-up of 77±42 months, 7 patients (2%) died (1 as a result of an inappropriate shock), and 46 patients (12%) had appropriate device therapy (5±5 shocks per patient). Appropriate device therapy rates at 10 years were 48% for patients whose implantable cardioverter-defibrillator indication was aborted sudden cardiac arrest, 19% for those whose indication was syncope, and 12% for the patients who were asymptomatic at implantation. At 10 years, rates of inappropriate shock and lead failure were 37% and 29%, respectively. Inappropriate shock occurred in 91 patients (24%; 4±4 shocks per patient) because of lead failure (n=38), supraventricular tachycardia (n=20), T-wave oversensing (n=14), or sinus tachycardia (n=12). Importantly, introduction of remote monitoring, programming a high single ventricular fibrillation zone (>210-220 bpm), and a long detection time were associated with a reduced risk of inappropriate shock. CONCLUSIONS: Appropriate therapies are more prevalent in symptomatic Brugada syndrome patients but are not insignificant in asymptomatic patients (1%/y). Optimal implantable cardioverter-defibrillator programming and follow-up dramatically reduce inappropriate shock. However, lead failure remains a major problem in this population.